Provider Demographics
NPI:1841631892
Name:BOLLES, NICHOLE M
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:M
Last Name:BOLLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9302
Mailing Address - Country:US
Mailing Address - Phone:585-322-3058
Mailing Address - Fax:
Practice Address - Street 1:2314 STEDMAN RD
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-9568
Practice Address - Country:US
Practice Address - Phone:585-322-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist